Among the groups of severe-diagnosis claims that Medicare receives, major joint replacement or joint reattachment is among the highest, according to the Centers of Medicare & Medicaid Services (CMS).
A physician’s examination of the joints would entail identifying deformity, range of motion limitations, crepitus (sound when moving a joint), effusions (swollen joints), tenderness and gait abnormalities. Tests may include X-rays and imaging. Medicare recipients are eligible for coverage of X-rays and diagnostic laboratory tests under Part B Medicare benefits. Part B may help cover any medically necessary care and services in a doctor’s office or outpatient clinic.
Prevalence of arthritic joint pain
The American Journal of Sports Medicine has noted that joint replacement surgery is one of the most successful treatments administered to those with arthritic joints because it alleviates suffering and improves movement. However, artificial joint replacements usually only last for about 10 years, leading to what is referred to as revision surgeries.
If you experience stiffness, discomfort and difficulty moving, see your personal physician for diagnosis and treatment. If surgery is recommended, Medicare recipients should verify coverage with their plan administrator.
Medicare Benefits for Joint Replacements
When a claim is filed for major joint replacement surgery, technically called arthroplasty, Medicare expects to see medical records that show an attempt to resolve the issue through other treatments rather than moving directly to a surgical solution. The claim that the Medicare recipient needs surgery must include detail supporting the determination that the procedure is reasonable and essential. Supporting documents would encompass comprehensive medical records with patient history and clinical results.
If approved and your care falls within the scope of Medicare Part B, a yearly deductible will apply before the Medicare recipient is responsible for generally 20% of the Medicare-approved cost of the services, assuming the provider accepts assignment. The term assignment refers to the acceptance by the doctor, provider or supplier of the Medicare-approved amount as payment in full.
If your care takes place when you are formally admitted into a hospital or skilled nursing facility, Medicare Part A may help cover your joint replacement. Part A covers inpatient hospital care or care in a skilled nursing facility that is neither custodial nor long-term care. Keep in mind that exact costs of surgery may be difficult to predict in advance. However, you can come up with an estimate by consulting with the insurance contact at your medical facility, finding out if you have a choice between an ambulatory surgical center and hospital outpatient department, verifying if you need to be an inpatient, checking any secondary insurance you may have and calculating your deductible based on amounts already applied to your deductible in the current year.